[Rape and the "minute-after" law in Minas Gerais, Brazil: socio-demographic factors associated with emergency prophylaxis]. / Estupro e lei do minuto seguinte em Minas Gerais, Brasil: fatores sociodemográficos associados às profilaxias de emergência.

This research project investigated the relationship between sociodemographic characteristics of girls and women who were the victims of rape of in Minas Gerais between 2013 and 2021, and the likelihood of receiving emergency treatment as stipulated in Law No. 12,845/2013, known as the "Minute-After" (Minuto Seguinte) Law. Data from the Notifiable Diseases Information System (SINAN) for rape cases were used to estimate binary choice models. The results indicate that the sociodemographic factors of the victims, aligned with the theory and practice of intersectionality (race, age, place of residence within health regions, relationship with the perpetrator, and year of crime registration), negatively influence the probability of receiving emergency treatment. Specifically, indigenous victims, minors, those raped by acquaintances, and residents in certain health regions, were found to have a lower probability of receiving immediate medical care after rape. Furthermore, it was found that the implementation of public policy did not result in an improvement, as there has been a decrease in the number of medical appointments since the enactment of the law in 2013 through to the year 2021.

Esta pesquisa investigou a relação entre características sociodemográficas das meninas e mulheres vítimas de estupro em Minas Gerais, no período de 2013 a 2021, e a probabilidade de receberem tratamentos de emergência, conforme estabelecido na Lei nº 12.845/2013, conhecida como Lei do Minuto Seguinte. Utilizou-se os dados do Sistema de Informação de Agravos de Notificação (SINAN) para casos de estupro para estimação de modelos de escolhas binárias. Os resultados indicam que fatores sociodemográficos das vítimas, alinhados à teoria e à prática da interseccionalidade (raça, idade, local de residência dentro das regiões de saúde, relação com o agressor e ano do registro do crime) influenciam, negativamente, a probabilidade de receberem o tratamento de emergência. Em particular, vítimas indígenas, menores de idade, agredidas por conhecidos e residentes em determinadas regiões de saúde demonstraram ter menor probabilidade de receber cuidados médicos imediatos. após o estupro. Além disso, constatou-se que a implementação da política pública não resultou em melhoria, já que, desde a promulgação da Lei, em 2013, até o ano 2021, houve diminuição no número de atendimentos médicos realizados.

Legalidade e ética entre obstetras do serviço de aborto legal em Alagoas no atendimento às vítimas de estupro / Legality and ethics among obstetricians of the legal abortion service in Alagoas during the care for rape victims

Objetivo: Determinar o perfil ético profissional dos obstetras do serviço de aborto legal no estado de Alagoas (Brasil) e delinear um protocolo e fluxograma para auxiliar no atendimento de mulheres estupradas. Métodos: Realizamos um estudo observacional-transversal, prospectivo e descritivo, incluindo todos os 26 obstetras do serviço de aborto legal. Na fase 1, investigaram-se o conhecimento legal e a posição ética, enquanto na fase 2 foram construídos um protocolo e um fluxograma para guiar o serviço nos casos de aborto legal. Resultados: Na fase 1, identificamos que a maioria dos obstetras não conhecia os aspectos legais sobre o aborto, não se sentiam confortáveis em estar no serviço e apontaram várias limitações no funcionamento dele. Na fase 2, foram desenvolvidos um protocolo e um fluxograma aplicados aos casos em que uma mulher estuprada deseja abortar por métodos legais. Conclusão: O perfil dos obstetras do serviço de aborto legal é insuficiente para lidar com a complexidade do aborto no estado. O protocolo e o fluxograma delineados tiveram o propósito de ajudar o serviço de aborto legal do estado a lidar com esse problema público/social.(AU)

Objective: To determine the professional ethical profile of obstetricians from the legal abortion service in Alagoas state (Brazil) and to design a protocol and flowchart to help the attendance of raped woman. Methods: We performed an observational- -sectional, prospective and descriptive study including all 26 obstetricians from the legal abortion service. Phase 1 investigated the legal knowledge and ethical position, while phase 2 was the construction of a protocol and flowchart to guide the service in cases of legal abortion. Results: In the phase 1 we identified that most obstetrician did not know the legal aspects about abortion; did not few comfortable to be in the service and they pointed out several limitations of how service works. Phase 2 of the study was the development of a protocol and flowchart applied to the cases which a raped woman wants to abort by legal methods. Conclusion: The profile of obstetrician from the legal abortion service is insufficient to deal with the complexity of abort in the state. The protocol designed have the purpose to help the state legal abortion service to deal with this public/social problem.(AU)

Resgate histórico do primeiro programa público de interrupção da gestação por estupro no Brasil / Historical rescue of the first public rape pregnancy program in Brazil

Os autores apresentam a evolução histórica dos caminhos percorridos até a criação do primeiro programa público de interrupção legal da gestação no Brasil. Mencionam o atendimento antes desse programa, que era realizado por poucos, de maneira dissimulada e sem publicidade nem publicações para a preservação das equipes. Mencionam como o Hospital Municipal Dr. Arthur Ribeiro de Saboya foi escolhido para esse desafio. Resgatam a luta das mulheres e dos movimentos feministas, e a criação da portaria que determinava a obrigatoriedade do atendimento para a realização do abortamento legal nos casos de antijuricidade, pela Prefeitura Municipal de São Paulo. Mencionam os difíceis caminhos até a constituição das equipes de atendimento e o desenrolar de uma sequência de fatos históricos, passando pelo início do atendimento imediato às vítimas no sentido de realizar as profilaxias pertinentes, a utilização de aspiração manual intrauterina (AMIU) como técnica principal para atendimento ao abortamento em todas as suas situações, os Fóruns Nacionais de Aborto Legal realizados pelo Cemicamp, Ministério da Saúde e Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo), entre outros, que culminaram com tudo o que temos hoje em termos de atendimento integral à saúde da mulher, mormente no que tange aos direitos sexuais e reprodutivos, à violência sexual e à interrupção legal da gestação.(AU)

The authors present the historical evolution of the paths traveled until the creation of the First Public Program for Legal Interruption of Pregnancy in Brazil. They mention the care before this program that was carried out by a few, in a covert way and without advertisements or publications for the preservation of the team. Mention as the Municipal Hospital Dr. Arthur Ribeiro de Saboya was chosen for this challenge. They rescued the struggle of women and feminist movements, the creation of the ordinance that determined the mandatory care for the performance of legal abortion in cases of anti-juristy, by the city of São Paulo. They mention the difficult paths to the constitution of care teams and the development of a sequence of historical facts, through the beginning of immediate care to victims in order to perform the relevant prophylaxis, in the use of the AMIU as the main technique for abortion care in all its situations, the National Legal Abortion Forums held by Cemicamp, Ministry of Health and Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo), among others, which culminated in all that we have today in terms of comprehensive care for women's health, especially with regard to sexual and reproductive rights, sexual violence and legal interruption of pregnancy.(AU)

La interrupción legal del embarazo en Argentina / The legal termination of pregnancy in Argentina

En el contexto de la publicación por parte del Ministerio de Salud de la Nación de Argentina del Protocolo para la atenciónintegral de las personas con derecho a la interrupción legal del embarazo (ILE), resumido y comentado en este mismonúmero de EVIDENCIA, este comentario editorial ofrece: 1) una perspectiva amplia de lo que significa el aborto, desde lamirada estrictamente biologicista hasta definiciones basadas en el enfoque de género; 2) una descripción de los diferentesmarcos jurídicos respecto del aborto que imperan actualmente en Latinoamérica y Argentina, haciendo especial hincapiéen lo concerniente a las ILE; 3) información epidemiológica sobre la mortalidad materna en Argentina y la asociada alaborto inseguro; 4) estadísticas sobre la realización de ILE en la Ciudad Autónoma de Buenos Aires, Argentina.Dada la situación actual de aislamiento social preventivo obligatorio en el marco de la pandemia de Covid-19, conside-ramos quienes integramos equipos de salud debemos estar más atentos/as que nunca a las situaciones de violenciapotencial que podrían suceder en este contexto, para dar las respuestas pertinentes -entre las que se incluyen las ILE-, alas víctimas de embarazos no deseados consecutivos a situaciones de coerción. (AU)

In the context of the publication by the Argentine Ministry of Health of the Protocol for the comprehensive care of people withthe right to legal termination of pregnancy (LTP), summarized and commented on in this same issue of EVIDENCIA, thiseditorial article offers: 1) a broad perspective of what abortion means, from a strictly biological point of view to definitionsbased on the gender approach; 2) a description of the different legal frameworks regarding abortion that currently prevailin Latin America and Argentina, with special emphasis on LTP; 3) epidemiological information on maternal mortality inArgentina and that associated with unsafe abortion; 4) statistics on the realization of LTP in the Autonomous City ofBuenos Aires, Argentina.Given the current situation of mandatory preventive social isolation in the framework of the Covid-19 pandemic, we considerthat those of us who are part of health teams should be more alert than ever to situations of potential violence that couldoccur in this context, to give the relevant responses - including LTP- to victims of unwanted pregnancies following coercivesituations. (AU)

Factors Related to Rape Reporting Behavior in Brazil: Examining the Role of Spatio-Temporal Factors.

The reporting of rape to police is an important component of this crime to have the criminal justice system involved and, potentially, punish offenders. However, for a number of reasons (fear of retribution, self-blame, etc.), most rapes are not reported to police. Most often, the research investigating this phenomenon considers incident and victim factors with little attention to the spatio-temporal factors of the rape. In this study, we consider incident, victim, and spatio-temporal factors relating to rape reporting in Campinas, Brazil. Our primary research question is whether or not the spatio-temporal factors play a significant role in the reporting of rape, over and above incident and victim factors. The subjects under study are women who were admitted to the Women's Integrated Healthcare Center at the State University of Campinas, Brazil, and surveyed by a psychologist or a social worker. Rape reporting to police was measured using a dichotomous variable. Logistic regression was used to predict the probability of rape reporting based on incident, victim, and spatio-temporal factors. Although we find that incident and victim factors matter for rape reporting, spatio-temporal factors (rape/home location and whether the rape was in a private or public place) play an important role in rape reporting, similar to the literature that considers these factors. This result has significant implications for sexual violence education. Only when we know why women decide not to report a rape may we begin to work on strategies to overcome these hurdles.

Sexualidade infantojuvenil e judicialização / Children and adolescent sexuality and judicialization / Sexualidad infanto-juvenil y judicialización

Este artigo visa mostrar modos de judicialização da sexualidade infantojuvenil, principalmente através da negação desta sexualidade como um direito, restringindo-a apenas à contravenção e suas punições. Também, discute o chamado abuso sexual e um novo dispositivo de controle da sexualidade chamado estupro de vulnerável. Mostra como a biopolítica vai ampliando a governamentalidade da conduta sexual de crianças e adolescentes, usando como estratégia a punição das relações sexuais com menores de 14 anos. (AU)

This article seeks to show ways in which children and adolescent's sexuality becomes a justiciable issue by exploring the dichotomy of denial of children an adolescent's sexuality as a right at the same time that it is taken for granted in cases of transgression and punishment. In addition it discusses the so called sexual abuse and a new sexuality control apparatus called rape of the vulnerable. It shows how biopolitics is expanding the governmentality of sexual conduct of children and teens, using the strategy of punishment of below 14 years old sexual relations. (AU)

Este artículo se propone a presentar modos de judicialización de la sexualidad infanto-juvenil, principalmente a través de la negación de esta sexualidad como un derecho, retringiéndo la apenas a la contravención y a los castigos. También discute el denominado abuso sexual y un nuevo dispositivo de control de la sexualidad denominado violación de vulnerable. Muestra como la biopolítica amplía poco a poco la gubernamentalidad de la conducta sexual de niños y adolescentes, usando como estrategia el castigo de las relaciones sexuales con menores de 14 años. (AU)

Effective Reparation for the Guatemala S.T.D. Experiments: A Victim-Centered Approach.

Discussion of reparations for U.S.-Guatemala STD experiments of the 1940s and 50s should be informed by a range of international and U.S. reparation experiences, so that features that impair the effectiveness of repair are avoided, and features that enhance effectiveness of repair are emulated. Two features have contributed to the effectiveness or ineffectiveness of repair elsewhere but have not been critically examined in relation to the Guatemalan experiments: Whether experimental subjects or their families have the opportunity to participate in reparations processes, and whether any group of experimental subjects is intentionally denied recognition. Three advantages of victim participation are explored, and a critique provided of one narrow delimitation of victims. Even if political and moral failings ultimately prevent reparations for Guatemalan experimental subjects, an emphasis on effectiveness and victim-centeredness should nonetheless shape reparations for other, future victims of human rights abuses in experimentation.

Opinión de estudiantes de medicina sobre la legalización del aborto en casos de violación, y sus factores asociados, Perú, 2015 / Opinion of medical students about the legalization of abortion after rape, and its associated factors. Peru, 2015

Objetivo: describir la opinión de estudiantes de medicina de Perú sobre la legalización del aborto por violación y evaluar sus factores asociados. Material y Métodos: estudio observacional, transversal y analítico, en estudiantes de Medicina Humana que asistieron a alguna de las dos asambleas estudiantiles nacionales realizadas en la ciudad de Trujillo durante el 2015. Se aplicó una encuesta de 25 preguntas que recolectó variables sociodemográficas e información sobre la opinión de los estudiantes sobre la legalización del aborto. Los factores asociados a estar a favor de la legalización del aborto en casos de violación se evaluaron mediante la regresión de Poisson con varianza robusta, obteniendo razones de prevalencia (RP) y sus intervalos de confianza al 95% (IC95%). Resultados: se encuestó a 142 estudiantes de Medicina Humana. El 53,5% fueron mujeres, el 62,7% se encontraban estudiando en universidades fuera de Lima y el 44,0% se encontraban entre quinto y octavo semestre. El 57,5% estuvieron de acuerdo con la legalización del aborto en casos de violación, lo cual estuvo asociado a mayor compromiso religioso (RP=0,50; IC95%=0,30-0,84) y a la aprobación familiar de la legalización del aborto (RP=1,39, IC95%=1,08-1,80). Conclusiones: aproximadamente la mitad de los encuestados estuvo de acuerdo con la legalización del aborto en casos de violación. Esto estuvo asociado a tener un menor compromiso religioso y a que su familia apruebe la legalización del aborto, lo cual resalta la importancia del entorno familiar y religioso en este tema.

Objective: to describe the opinion of Peruvian medical students about the legalization of abortion in cases of rape, and to address its associated factors. Material and Methods: an observational, cross-sectional and analytical study was performed in medical students who attended any of the two national student assemblies that took place in the city of Trujillo during 2015. A 25-question survey was administered, which included socio-demographic variables and information regarding the students’ opinion about abortion legalization. Factors associated with favoring abortion legalization in cases of rape were assessed using Poisson regression with robust variance, obtaining prevalence ratios (PR) and 95% confidence intervals (CI). Results: we surveyed 142 medical students. Fifty-three and a half per cent were women, 62.7% were studying in universities outside Lima and 44.0 % were between fifth and eighth semester. Fifty-seven and a half percent of the students agreed with legalizing abortion in cases of rape, which was associated with religious commitment (PR = 0.50, 95% CI = 0.30-0.84) and with the approval of such legalization by their relatives (PR = 1.39, 95% CI = 1.08 to 1.80). Conclusions: Half of the participants agreed that abortion should be legalized in cases of rape. This was associated with having a more relaxed religious commitment and with the approval of abortion legalization by their relatives, which highlights the importance of the family and religious environment in this issue.

[Medicolegal considerations about rape as a reason to decriminalize abortion]. / Consideraciones médico-legales sobre causal de violación contenida en el proyecto de Ley de Aborto actualmente en trámite.

The Chilean senate is discussing a proposal to decriminalize abortion in 3 causals. One of these is when the pregnancy occurs as a result of a rape. To be legally able to perform the abortion in this circumstance, a health care team must confirm the occurrence of the facts constituting the offence. Regardless of the patient’s will, the accusation will be reported to the justice. In our view, in its current status the proposed rule does not consider certain medicolegal and procedural topics. Those flaws may determine in certain scenarios critical problems, such as: a) a wrongful conviction as a consequence of a false allegation of rape; (b) some pregnant due to a rape will not have access to the abortion procedure; (c) some accusations of rape will not be accredited nor criminally sanctioned. Employing a fictional case, we illustrate how those scenarios can actually be seen in practice. We also emphasize the difficulties and limitations that the health care team will encounter if the project is approved under the current conditions. Finally, we encourage the professional societies implicated in the theme to contribute in the legislatorial debate. Therefore, we give a set of proposals aimed to improve the bill before it may be enacted as a law.

Human rights accountability for maternal death and failure to provide safe, legal abortion: the significance of two ground-breaking CEDAW decisions.

In 2011, the Committee on the Elimination of Discrimination against Women (CEDAW) issued two landmark decisions. In Alyne da Silva Pimentel v. Brazil, the first maternal death case decided by an international human rights body, it confirms that States have a human rights obligation to guarantee that all women, irrespective of their income or racial background, have access to timely, non-discriminatory, and appropriate maternal health services. In L.C. v. Peru, concerning a 13-year-old rape victim who was denied a therapeutic abortion and had an operation on her spine delayed that left her seriously disabled as a result, it established that the State should guarantee access to abortion when a woman's physical or mental health is in danger, decriminalise abortion when pregnancy results from rape or sexual abuse, review its restrictive interpretation of therapeutic abortion and establish a mechanism to ensure that reproductive rights are understood and observed in all health care facilities. Both cases affirm that accessible and good quality health services are vital to women's human rights and expand States' obligations in relation to these. They also affirm that States must ensure national accountability for sexual and reproductive health rights, and provide remedies and redress in the event of violations. And they reaffirm the importance of international human rights bodies as sources of accountability for sexual and reproductive rights violations, especially where national accountability is absent or ineffective.

Estado actual de la población víctima de desplazamiento forzado en cuanto al enfoque diferencial de su atención, el derecho a la integridad, la subsistencia mínima y al ingreso económico / Current status of the population victim of forced displacement as for its differential approach of its attention, the right to integrity, the minimum sustenance and the economic income

El siguiente artículo recoge algunos aspectos de la investigación que sobre el Goce Efectivo de Derechos (Informe GED) elaborara el Observatorio Departamental de Desplazamiento Forzado de Antioquia en 2011. En esta entrega, la tercera de una serie de cuatro, se recogen algunos contenidos, metodologías de la medición, diseño de indicadores y resultados que arrojara el informe GED. En particular, en este aparte se exponen aspectos relativos a la atención de la población víctima del desplazamiento en términos del respeto a su integridad y las garantías para obtener un tratamiento acorde al enfoque diferencial. Así mismo, se tratan los diseños y resultados de la medición de los indicadores sociales sobre garantías de subsistencia mínima y alcance de la cobertura de ingresos económicos y educación en la población de estudio.

The following article contains some aspects of the research that about the effective enjoyment of rights (EER report) developed by the State Observatory of Forced Displacement in Antioquia in 2011. In this installment, the third in a series of four, the measurement methodologies, the design of indicators, and the results which the EER report will produce, are included. In particular, in this supplement, aspects relating to the care of the victims of displacement in terms of respect for their integrity and guarantees to obtain a treatment according to the differential approach. It also shows the design and the results of the measurement of the social indicators about the warranty of minimum sustenance and the scope of the coverage of the economic income and education, in the population under study.

Moção de repúdio nº 005, de 12 de abril de 2012: vem a público manifestar repúdio em relação à decisão tomada pela ministra Maria Thereza de Assis Moura que não considerou crime o ato praticado pelo agressor / Repudiation motion No. 005, dated April 12, 2012: public rejection of the decision taken by Minister Maria Thereza de Assis Moura who did not consider the act of the aggressor to be a crime

Vem a público manifestar repúdio em relação à decisão tomada pela ministra Maria Thereza de Assis Moura que não considerou crime o ato praticado pelo agressor.

[The "morning after pill": the impact of the Supreme Court ruling in the medical field]. / Píldora de emergencia: las repercusiones del fallo de la Suprema Corte en el ambito médico.

This article summarizes the Court's ruling regarding the constitutionality of the Official Norm "NOM-046-SSA2-2005". Jalisco's Governor challenged the validity of the referred norm arguing that it was against articles 4, 5, 14, 16, 20, 21, 29, 31-V, 49, 73, 74, 89-I, 123, 124 y 133 of the Federal Constitution. The Supreme Court disregarded Governor's claim and determined that the members of the National Health System are obliged to offer and give the "day after pill" to sexual violation victims. According to article 5 of General Health Law, the National Health System includes private and public hospitals, whether they are local or federal. This means that all these health institutions have the obligation to observe the dispositions contained in the appealed Official Norm Given the significance of the Court's ruling in the medical sphere, in this article the most relevant issues of the Court decision and its implications are analyzed.

Recomendação nº 044 de 10 de outubro de 2008: recomenda que o Conselho Nacional de Saúde envie correspondência com informações, a todas as instâncias do Poder Judiciário para que atentem para o cumprimento no disposto do Código Penal Brasileiro que não aponta a necessidade de BO (Boletim de Ocorrência), nem ordem judicial para a realização da interrupção legal da gestação, tendo em vista a ocorrência de casos de exigência desse tipo em diferentes lugares do País / Recommendation No. 044 of October 10, 2008: recommends that the National Health Council send correspondence with information to all instances of the Judiciary so that they comply with the provisions of the Brazilian Penal Code that do not indicate the need for BO (Boletim of Occurrence), nor a court order to carry out the legal interruption of pregnancy

Recomenda que o Conselho Nacional de Saúde envie correspondência com informações, a todas as instâncias do Poder Judiciário para que atentem para o cumprimento no disposto do Código Penal Brasileiro que não aponta a necessidade de BO (Boletim de Ocorrência), nem ordem judicial para a realização da interrupção legal da gestação, tendo em vista a ocorrência de casos de exigência desse tipo em diferentes lugares do País.

Drug consumption among sexual offenders against females.

This article aims to evaluate the role of drug consumption among sexual offenders against females. Three groups of participants (N = 133) comprising sexual offenders against girls, pubertal females, and women were examined with reference to history of drug and/or alcohol use, impulsivity level, sexual addiction, and recidivism risk. Sexual offenders against women were found to have significantly more difficulties with drug use, higher impulsivity level, and to be younger than the sexual offenders against girls and pubertal females. The combination of drug consumption and higher level of impulsivity may contribute to sexual aggression against adult females.